Subcutaneous immunoglobulin in myasthenia gravis exacerbation

Beecher, Grayson; Anderson, Dustin; Siddiqi, Zaeem A.

doi:10.1212/wnl.0000000000004365

Cited by 42 publications

(35 citation statements)

References 24 publications

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“…Switching from IVIG to SCIG seems to be an effective strategy that attenuates immunoglobulin-induced adverse effects, especially for patients who have previously experienced severe adverse effects or are at high risk of developing adverse effects. An increasing number of well-designed studies show that SCIG can be used as a treatment for immunodeficiency diseases, multifocal motor neuropathy, chronic inflammatory demyelinating polyneuropathy, and myasthenia gravis ( 6 , 122 – 136 ) (Table 3 ). The results of two randomized, crossover studies indicate that the rate of systematic adverse effects was lower following SCIG than following IVIG, and no severe adverse effects were reported in patients treated with SCIG ( 123 , 135 ).…”

Section: Preventive Measuresmentioning

confidence: 99%

Adverse Effects of Immunoglobulin Therapy

et al. 2018

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Immunoglobulin has been widely used in a variety of diseases, including primary and secondary immunodeficiency diseases, neuromuscular diseases, and Kawasaki disease. Although a large number of clinical trials have demonstrated that immunoglobulin is effective and well tolerated, various adverse effects have been reported. The majority of these events, such as flushing, headache, malaise, fever, chills, fatigue and lethargy, are transient and mild. However, some rare side effects, including renal impairment, thrombosis, arrhythmia, aseptic meningitis, hemolytic anemia, and transfusion-related acute lung injury (TRALI), are serious. These adverse effects are associated with specific immunoglobulin preparations and individual differences. Performing an early assessment of risk factors, infusing at a slow rate, premedicating, and switching from intravenous immunoglobulin (IVIG) to subcutaneous immunoglobulin (SCIG) can minimize these adverse effects. Adverse effects are rarely disabling or fatal, treatment mainly involves supportive measures, and the majority of affected patients have a good prognosis.

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Section: Preventive Measuresmentioning

confidence: 99%

Adverse Effects of Immunoglobulin Therapy

et al. 2018

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“…A prospective, single‐center, open‐label study was recently published on the effects of SCIg in patients with mild to moderate gMG exacerbation 99 . Twenty‐two patients were included in the study and received 2‐g/kg dose of SCIg in a dose‐escalating manner over a 4‐week period.…”

Section: Recent and Ongoing Clinical Trials In Mgmentioning

confidence: 99%

“…Significant reductions were seen in the primary (QMG) and secondary (manual muscle testing, MG‐ADL, and MGC) endpoints at 6 weeks. High degree of satisfaction was reported on the Treatment Satisfaction Questionnaire for Medication (TSQM) in the domains of effectiveness, side effects, and convenience, and there were no serious side effects 99 …”

Section: Recent and Ongoing Clinical Trials In Mgmentioning

confidence: 99%

Update on immune‐mediated therapies for myasthenia gravis

2020

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With the exception of thymectomy, immune modulatory treatment strategies and clinical trials in myasthenia gravis over the past 50 y were mainly borrowed from experience in other nonneurologic autoimmune disorders. The current experimental therapy paradigm has significantly changed such that treatments directed against the pathological mechanisms specific to myasthenia gravis are being tested, in some cases as the initial disease indication. Key advances have been made in three areas: (i) the expanded role and long-term benefits of thymectomy, (ii) complement inhibition to prevent antibodymediated postsynaptic membrane damage, and (iii) neonatal Fc receptor (FcRn) inhibition as in vivo apheresis, removing pathogenic antibodies. Herein, we discuss these advances and the potential for these newer therapies to significantly influence the current treatment paradigms. While these therapies provide exciting new options with rapid efficacy, there are anticipated challenges to their use, especially in terms of a dramatic increase in cost of care for some patients with myasthenia gravis.

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“…A retrospective cohort study indicated that a wide spectrum of MG patients, seropositive, seronegative, thymomatous, and with varying disease severity and duration, could be treated with SCIG or transitioned from IVIG to SCIG with clinical benefit, safety, and tolerability . A prospective open‐label trial found that in patients with a mild to moderate MG exacerbation, treatment with SCIG 0.5 g/kg weekly for 4 weeks leads to statistically significant clinical improvement at 6 weeks with most common side effects of mild headache and injection site reactions but with overall high degree of treatment satisfaction, safety, and tolerability …”

Section: Novel Immune‐based Therapeutic Approachesmentioning

confidence: 99%

Immunosuppressive and immunomodulatory therapies for neuromuscular diseases. Part II: New and novel agents

et al. 2019

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While traditional immunosuppressive and immunomodulatory therapies remain the cornerstone of immune-mediated neuromuscular disease management, new and novel agents including antigen-specific, monoclonal antibody drugs, have emerged as important treatment options. This article is the second of a two-part series that reviews immune-based therapies in neuromuscular diseases. The first article provides an update on the use of traditional immune-based therapies such as corticosteroids, plasma exchange, steroid-sparing immunosuppressive drugs, and intravenous immunoglobulin G. This second article focuses on new and novel immune-based therapies, including eculizumab, a complement inhibitor approved for acetylcholine receptor antibody-positive myasthenia gravis; rituximab, a B-cell depletion therapy with evolving indications in neuromuscular diseases; and the subcutaneous formulation of immunoglobulin G that gained approval for use in chronic inflammatory demyelinating polyradiculoneuropathy in 2018. Finally, several novel antigen-specific drugs at different stages of investigation in neuromuscular disease are also reviewed. K E Y W O R D S biologic drugs, eculizumab, efgartigimod, monoclonal antibody, rituximab, subcutaneous immunoglobulin G

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Subcutaneous immunoglobulin in myasthenia gravis exacerbation

Abstract: This study provides Class IV evidence that in patients with mild to moderate MG exacerbation, SCIg is safe and effective in reducing MG disability measures.

Cited by 42 publications

References 24 publications

Adverse Effects of Immunoglobulin Therapy

Adverse Effects of Immunoglobulin Therapy

Update on immune‐mediated therapies for myasthenia gravis

Immunosuppressive and immunomodulatory therapies for neuromuscular diseases. Part II: New and novel agents

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